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Managing the costs of healthcare

As we age, health and care costs begin to present a gloomy picture. Not only are we more likely to fall ill and require medical treatment, but our health needs grow at a time when, according to YourLifeChoices Retirement Affordability Survey 2017-18 , 81 per cent of us fear running out of money.

While we are living longer, an increasing number of Australians are likely to require treatment for the chronic conditions that afflict many, often as a result of modern diet and lifestyles.

According to ABS figures, 50 per cent of Australians have at least one significant chronic condition, such as arthritis, cancer or cardiovascular disease. This climbs in later years, with three in every five people aged over 65 reporting two or more chronic conditions.

Surgical expenses for such common procedures as hip replacements can typically add $5500 to out-of- pocket costs, unless you are prepared to wait months for a public hospital operation.

Australians out-of-pocket health costs are among the highest in the developed world, according to Organisation for Economic Co-operation and Development (OECD) figures. Recently, the Breast Cancer Network Australia reported that a quarter of women who completed their survey faced out-ofpocket costs of more than $17,200, with a quarter of privately-insured women reporting out-of-pocket costs of more than $21,000.

For single, older women whose resources are more likely to be meagre, such costs may mean waiting longer for the right treatment. The YourLifeChoices survey of the six retirement income tribes’ expenditure on healthcare, including health insurance, shows the striking range in weekly expenditure on this category, from $138 by a couple on private income to the $34 spent by the pensioner couple who are renting. While the affluent couple can afford to spend 10 per cent of their $73,524 annual expenditure on health, the cash-strapped couple can only afford to spend five per cent of their $35,594. There is, however, an upside for older Australians when it comes to primary healthcare, one that is largely provided by GPs in the community.

Sydney University’s Family Medicine Research Centre has undertaken comprehensive surveys of GP activities and confirms that older Australians have increasingly relied on primary care health resources this century. Australians aged 65+ used about twice as many health resources as the average Australian. Since 2000, their use of services such as GPs, medication, imaging and pathology has risen by 18 per cent relative to the rest of the population. The positive aspect of patients being largely managed by GPs is that expensive specialist and hospital visits are bypassed and overall healthcare costs are reduced.

This is important when 60 per cent of people aged 65+ have three or more diagnosed chronic conditions and one-in-four have five or more. Onethird of older patients visiting their GPs are living with chronic pain, which is nearly always treated with medication. The negative aspect of this is that older patients are taking more medications (just over five on average), which is known to increase the risk of adverse drug reactions.

The positive and negative experiences of older Australians in relation to the health system were highlighted in the recently released ABS Survey of Health Care. The survey indicated that older people appear more satisfied, or less dissatisfied, with their healthcare compared to middle-aged people. While 27 per cent of people aged 45 to 65 felt they waited longer than acceptable to see a specialist, only 18 per cent of those aged 65 and over expressed the same experience. A similar response came with waiting time to see GPs, with 20 per cent of those aged 45–65 expressing dissatisfaction compared to only 12 per cent of those over 65 years of age.

A further surprise was that even though the over-65s are more likely to visit their GP, it was those aged 45–64 who were more than twice as likely to indicate that the cost of an appointment was a reason for not seeing a GP, even when they felt it necessary. One possible explanation is that GPs are more likely to bulk bill the 65+ patients because of their pensioner status. But it also shows that being older is not all bad news when it comes to healthcare.

The good and the bad of ageing and healthcare are revealed more strikingly with experiences related to hospital care. The over-65s, who as a group are more likely to have had a hospital stay, report a significantly more positive experience when it comes to whether their GP or other carers seemed informed about their follow-up needs and medication changes. In the survey, 73 per cent said their doctors or carers were informed compared to 58 per cent in the 45–65 age group who said they were not.

It could be argued that these figures reveal experiences with healthcare at the margins. Yet these experiences represent the perspective of millions of Australians, are shared with their families and friends, and influence what the rest of us think. For many older people, especially those on a fixed income, the continuing rise in health insurance premiums poses a frustrating dilemma: the choice between coverage to avoid public hospital queues for elective surgery, or taking the chance with the public system to avoid the heavy drain on finite savings.

Some good news for older Australians on modest incomes is that as well as being more likely to receive higher subsidies or rebates against the cost of insurance, medical services are often bulk billed, meaning they face lower out-of-pocket costs. More importantly, the benefit of Australia’s community rating principle means that, despite their increased likelihood of conditions requiring expensive treatment, older Australians’ premiums remain the same as those of the young and healthy. However, for those referred to see a specialist outside hospital, there are high-cost barriers. The ABS survey shows that 45 per cent of those surveyed said that cost was a reason they did not see a specialist when they felt it was needed.

Despite Australia’s aspirations for a universal health system, the lived (and sometimes dying) experience of many shows that we are moving towards a two-tiered health system, where those with the means get treated and those without have to wait.

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Consumers Health Forum of Australia receives funding from the Australian Government as the peak national healthcare consumer organisation under the Health Peak and Advisory Bodies Programme.